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Laparoscopic surgery in pediatric urology
J Seibold1, G Janetschek, G Bartsch
1Department of Urology, University of Innsbruck, Austria.
Objectives:
In pediatric urology laparoscopy is more and more used for diagnostic and therapeutic indications.
Methods:
From January 1992 to August 1995, we performed 86 laparoscopic procedures in pediatric patients.
Results:
In 23 patients with cryptorchidism laparoscopy was used for diagnostic and/or therapeutic reasons. Laparoscopic repair of varicocele (n = 37) and hydrocele (n = 4) was performed. Vesicoureteral implantation was done in 6 patients and nephroureterectomy/heminephroureterectomy in 3 and 9 patients. In 2 patients vesical diverticulum were excised laparoscopically and in intersex laparoscopy was used in 2 patients.
Conclusion:
Laparoscopy is the most reliable diagnostic tool in children with cryptorchidism and allows, if necessary, therapy in the same procedure, such as orchiectomy or dissection of the testicular vessels in preparation for a Fowler-Stephens procedure. For varicocele repair the laparoscopic approach offers a simple and effective method with a low recurrence rate. More technically demanding and performed only in specialized centers are laparoscopic nephrectomy or heminephroureterectomy. These latter procedures have shown to be superior to the open surgical approach regarding morbidity, complication rate and hospital stay.